Chronic kidney disease (CKD) affects approximately 13% of people globally, including 20%-48% with type 2 diabetes (T2D), resulting in significant morbidity, mortality, and healthcare costs. There is an urgent need to increase early screening and intervention for CKD. We are experts in diabetology and nephrology in Central Europe and Israel. Herein, we review evidence supporting the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors for kidney protection and discuss barriers to early CKD diagnosis and treatment, including in our respective countries. SGLT2 inhibitors exert cardiorenal protective effects, demonstrated in the renal outcomes trials (EMPA-KIDNEY, DAPA-CKD, CREDENCE) of empagliflozin, dapagliflozin, and canagliflozin in patients with CKD. EMPA-KIDNEY demonstrated cardiorenal efficacy across the broadest renal range, regardless of T2D status. Renoprotective evidence also comes from large real-world studies. International guidelines recommend first-line SGLT2 inhibitors for patients with T2D and estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m2, and that glucagon-like peptide-1 receptor agonists may also be administered if required for additional glucose control. Although these guidelines recommend at least annual eGFR and urine albumin-to-creatinine ratio screening for patients with T2D, observational studies suggest that only half are screened. Diagnosis is hampered by asymptomatic early CKD and under-recognition among patients with T2D and clinicians, including limited knowledge/use of guidelines and resources. Based on our experience and on the literature, we recommend robust screening programmes, potentially with albuminuria self-testing, and SGLT2 inhibitor reimbursement at general practitioner (GP) and specialist levels. High-tech tools (artificial intelligence, smartphone apps, etc.) are providing exciting opportunities to identify high-risk individuals, self-screen, detect abnormalities in images, and assist with prescribing and treatment adherence. Better education is also needed, alongside provision of concise guidelines, enabling GPs to identify who would benefit from early initiation of renoprotective therapy; although, regardless of current renal function, cardiorenal protection is provided by SGLT2 inhibitor therapy.

2nd Department of Internal Medicine Victor Babes University of Medicine and Pharmacy Timisoara Romania

3rd Department of Internal Medicine 1st Faculty of Medicine Charles University Prague Prague Czech Republic

Centre for Molecular Research in Nephrology and Vascular Disease Victor Babes University of Medicine and Pharmacy Timisoara Romania

Department of Diabetology and Internal Medicine Medical University of Warsaw Warsaw Poland

Department of Endocrinology Diabetes and Metabolic Diseases Medical Centre University of Ljubljana Medical Faculty Ljubljana Slovenia

Department of Endocrinology Medical University Sofia Sofia Bulgaria

Department of Internal Medicine 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden

Department of Medicine and Oncology Semmelweis University Budapest Hungary

Department of Metabolic Diseases Jagiellonian University Medical College Kraków Poland

Diabetes and Endocrinology Clinic Clalit Medical Services Ramat Gan Israel

Diabetes Clinic Pius Brinzeu Emergency Hospital Timisoara Romania

Diabetes Unit Department of Endocrinology and Metabolism Hadassah Medical Centre Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel

Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel

Hospital of Internal Medicine Brüder Linz Linz Austria

Institute for Cardiovascular and Metabolic Research Linz Austria

Interdisciplinary Metabolic Medicine Trials Unit Division of Endocrinology and Diabetology Medical University of Graz Graz Austria

Regeneron Pharmaceuticals Tarrytown New York USA

University Digestive Health Care Centre Basel Clarunis Basel Switzerland

University Hospital Královské Vinohrady Prague Czech Republic

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